Orthopedic supportive frame



Nov. 12, l968 M. M. SAFFORD 3,410,553

ORTHOPEDIC SUPPORTIVE FRAME Filed April 29, 1966 /n venor Moyer /l/l.Safforo' n by United States Patent O 3,410,553 ORTHOPEDIC SUPPORTIVEFRAME Moyer M. Salford, Schenectady, N.Y., assignor to General ElectricCompany, a corporation of New York Filed Apr. 29, 1966, Ser. No. 546,2992 Claims. (Cl. 272-57) ABSTRACT OF THE DISCLOSURE An exercising deviceis described for use by paraplegic patients, who require buildup oftrunk and hip muscles. A single enclosing girding member, at least threeextensible support members depending therefrom and a stabilizer baseconnected to the lower ends of these support rnembers cooperate tomaintain a paraplegic patient (with lower extremities supported byseparate artificial support means) in the erect position during theperformance of physical exercise. The girding member is composed of atleast two arcuate pieces. One of the arcuate pieces hinged to thebalance of the girding member has a given single support member attachedthereto. By detaching the given single support member from thestabilizer base, separating one end of the one arcuate piece from thebalance of the girding member and rotating the one arcuate piecetogether with the given single support member attached thereto about thehinged connection, access for the patient into the girding member isreadily provided.

This invention relates to improvements in apparatuses for aiding theneuromuscular re-education of individuals suffering from paraplegia,wherein the entire lower half of the body is affected with motor andsensory paralysis.

For those patients possessed of good physical development and muscletone at the time of the onset of paraplegia, as for example .may occurfrom accidental damage to the spine, conventional physical therapydevices, such as parallel bars, wheel chairs, and exercising mats may bebenefically employed very soon after onset of this condition. However,in the case of paraplegia in a tall heavy person, in a person possessedof only very poor muscle tone because of obesity, age, etc., or in apoorly coordinated individual, conventional physical training devicesare usually beyond the muscular capacity of such people until after theyhave developed the requisite muscle power, particularly in the region ofthe trunk and hips. Unfortunately, for such paraplegics in very poorphysical condition the transition to a state of improved muscular poweris greatly hampered by the very limited opportunity for such patients tobe exposed to any exercises other than passive, single-muscle exercises.The most useful exercises for neuromuscular re-education and buildup ofmuscle power require the patient to be in the standing position andactively participate. For such patients, support with limited freedom ofmovement in the vertical position has been an insurmountable problem,not only because of the patients very real fear of falling and receivingfurther injury, but also because the long leg braces that must be wornto maintain the patient erect add considerably to the weight of thepatient setting even higher demands for the stability of the supportingapparatus.

The aforementioned long leg braces from which paraplegic patientsreceive support for standing, lock at the knees and the hips to preventcollapse of the standing patient by bending at the knees or topplingover by jackknng at the mid-section. Once having been moved to the erectposition, such a patient, when strong enough, can gain a degree ofmobility using crutches by employing a motion in which both legs areswung forward at the same time to a forward position, after which thecrutches rice are moved to a more advanced forward position for a newswinging motion.

As is well recognized, this method of locomotion is very awkward andrequires constant reliance on crutches. However, for such a patient tobe able to attempt to retrain the neuromuscular mechanism for thewalking exercise, which requires the extension of one leg at a time to aposition further ahead of the other leg, the hip lock (upper slip lock)of the long leg braces must be unlocked to enable the necessaryindependent swinging motion of the legs. If the patient does not havesuicient strength in the trunk and hip muscles for self-support of theupper part of the body, he will immediately jackknife upon loss of therigid support received from the long leg braces with the upper slip lockin the locked position.

Thus, for the type of patient referred to hereinabove a program ofneuromuscular re-education must precede the removal of this hiprestraint and the prime object of this invention is the provision of adevice to insure a safe and stable environment for the patent duringthis period of neuromuscular re-education of the muscles of the trunkand hip regions in order to upgrade the patient physically by techniquesof proprioceptive neuromuscular facilitation to the point at which sucha patient can profitably employ conventional therapeutic exercisedevices and techniques.

The philosophy of the treatment known as proprioceptive neuromuscularfacilitation is succinctly presented in the text book ProprioceptiveNeuromuscular Facilitation-Patterns and Techniques by Knott and Voss(copyright 1956, Paul B. Hoeber, Inc., Library of Congress Catalog CardNo. 56-5604) in column 2 of page 1. As stated therein this is aphilosophy olf muscular treatment based upon the ideas that all humanbeings respond in accordance with demand; that existing potentials maybe developed more fully; that movements must Ibe specific and directedtoward a goal; that activity is necessary to the best development ofstrength, coordination, and endurance; and that the stronger partsstrengthening weaker parts through cooperation lead toward a Igoal ofoptimum function.

The device of this invention has been shown to enable paraplegicpatients, who require muscular buildup of trunk and hip muscles toreceive proprioceptive neuromuscular facilitation while using thisdevice wherein vertically adjustable girding means are employed incombination with, and supported on, stabilizing means such that thepatients own weight is employed vto increase the stability of the devicetand obviate overturning thereof.

The unexpected advantages gained by the ability of this device to permitparaplegics to engage in a coniident manner in proprioceptiveneuromuscular facilitation of the trunk and hip muscles andsimultaneously to stimulate the activity of the neuromuscular network ofthe lower extremities which are supported, but not held immobile in thelong leg braces, is well illustrated by the fact that this device hasbeen built for, and used by, a patient suffering from a traumaticparaplegia secondary to the compression fracture of a portion odi thespinal column, which occurred in an automobile accident. This patientwas a tall, very heavy man of middle alge in poor physical condition.Attempts at neuromuscular re-education of this patient over a period ofeight months produced only slight improvement as indicated by muscleexaminations conducted during this period. This sulbstantial failure toprogress is believed to have been due to the patients inability to adaptto and properly utilize conventional training equipment, because of hispronounced apprehension and insecurity, which in turn appear to havebeen the products of his poor physical condition at the time of theonset of paraplegia. At this point, in time, the device described hereinwas invented and constructed specifically for this patient. The patientwas periodically placed erect (supported by long leg braces) within thegirt of the instant device and from this secure erect position he couldengage in complex activities, Iwhich require the simultaneous use ofboth hands, arms and shoulders, as `for example, catching and throwing abasket ball. In this way the patient was encouraged and enabled todirectly use and strengthen multiple sets of muscles in the trunk andneck and by stimulation to facilitate neuromuscular responses in thehip, knee, and even the ankle. In contrast to the preceding unproductiveeight month period, la period of one month of activity in the device ofthe instant invention provided substantial improvement.

Therefore, the contribution of this improvement in therapeutic devicesis its capacity to support the paraplegic patient (already equipped withlong leg braces) in an erect position with a degree of freedom enablingactive participation by the patient in many complex Inotion activitiesusing the muscles of the upper portion of the body to develop newabilities and greater strength and endurance in the patient rather thanlimiting the patient to largely straight motion activities.

Further, such patients can lbe gainfully employed at job tasks, whichmust be executed in an erect position, at a much earlier sta-ge thanwould otherwise be possible thereby regaining for the patient a lwageearning capacity. In order to provide for such use of this device,construction features have been incorporated therein to make the deviceeasily portable.

This device offers the additional advantage of enabling safe, verticalpositioning of a paraplegic patient as required to minimize theincidence of sores and similar discomforts accompanying constantoccupancy of a bed or wheel chair.

After the trunk muscles have been improved to a substantial degree theygirt can be lowered to permit even greater spiral and diagonal bodymotion. Then, when the hip muscles have gained suicient strength theheight of the leg braces can be reduced eliminating the former hipsupport and the patient, still relying upon orthopedic supportive frame,can continue strengthening the muscles of the hips and of lowerextremities with the rotative multi-muscle exercises promotingproprioceptive stimulation.

Other objects and many of the attendant advantages of this inventionwill be readily appreciated as the same become better understood byreference to the following detailed description when considered inconnection with the accompany drawings in which like reference numeralsdesignate like parts throughout the gures thereof and wherein:

FIG. 1 is a top plan view of the invention;

FIG. 2 is a side view thereof;

FIG. 3 shows the adjustable supports for the girt in greater detail andin partial cross-section, and

FIG. 4 shows a partial bottom View of the stabilizing base.

As shown in the drawings, the orthopedic supportive frame 1d is composedof the padded girt 11 preferably constr-ucted of arcuate pieces 12 and14 connected by means of separable hinges 14 and 15 supported on ad'-justable legs 16, 17, 18 and 19, which legs are firmly connected to thestabilizing base 21.

Girt 11 should be adjustable to heights of from about 36 inches to about60 inches and this'adjustrrient` is provided by the telescoping legconstruction shown in FIG. 3 in cooperation with extensible basemembers, the sliding arm extensions 22, disposed in recesses 23 locatedin the underside of platform 24 of base 21. Legs 16, 17, 18 and 19 areretained in position relative to the girt 11 by means of braces 25interconnecting the legs and girt 11. At the bottom end thereof each ofthe adjustable legs are connected to the base 21 by means of footadapters 26 connected to sliding arms 22 in some convenient manner.

In the structure shown herein one of the foot members has a slot Z7formed therein to permit separation of the leg 19 therefrom by aswinging motion after removal of the pin from hinge 15. If desired, part13 may be completely disconnected from part 12 by removing the pins fromeach of the separable hinges 14, 15. In like manner, braces 25 may bedisconnected from girt 11 by movement of slotted connections and theentire unit can be quickly collapsed for ease of transport. Likewise,the sliding arms 22 can be easily moved into recessed position in slots23 in the underside of platform 24 of stabilizer base 21 to take lessroom during carriage thereof.

In order to use the orthopedic supportive fra-me 10 it is necessary onlyto swing member 13 together with leg 19 to the position shown in dottedlines in FIG. l to enable introduction of the `patient harnessed in longleg braces into the device in the erect position standing on platform24. Closure of member 13 about the patient, reinsertion of the hinge pinin separable hinge 15 and reconnection of foot member 26 to theappropriate sliding arm 21 is all that is necessary to provide for thepatient a secure erect location where he can freely use both his hands,wrists, arms and shoulders, his neck and his trunk muscles in complexmovements requiring the use of multiple sets of muscles both in actionand reaction without fear of injury from falls. Initially, to gainconfidence the patient may only lean with his back against the girt 11until he is satised that he is receiving full support from the stand 10to prevent him from falling to any side. This confidence should becomeobvious to even the most insecure individual after a relatively shortexposure within the supportive frame 1d. After such conlidence has beengained, the patient soon begins to make use of the full degree offreedom available in the stand. At the onset, the patient may wish girt11 adjusted in the vicinity of the chest, but gradual improvement andcontidence will enable commensurate lowering of the girt until it is inthe region of the top of the vhip bone. With the exception of theplatform 24 of stabilizing base 21, which may be conveniently made ofwood, and the padding for the girt 11, all parts are preferably made ofa light metal, such as an aluminum alloy to provide a light, thoughstrong, unit.

The fact that the full weight of the patient together with theadditional weight of the long leg braces is directly and substantiallyvertically transmitted to the base 21 transforms the superstructure(legs, braces and girt) from an easily shiftable, and therebyunreliable, support for a paraplegic to a fully stable mechanism, whichin cooperation with conventional long leg braces is able to supply totalsupport for a paraplegic in a manner permitting considerable freedom ofmotion commensurate with the extent of the patients increasingcapabilities. Although the superstructure is detachable from thestabilizing base, its use separate from the base is not contemplated,since the superstructure alone offers no reliable support to a patientstill in need of leg braces above the knee, because of the danger ofunintentional shifting of the superstructure precisely when the patientneeds immovable support. Sideward shifting of the superstructure wouldbe particularly dangerous to such a patient. Thus, by the time theparaplegic patient will have recovered sufficiently to profitably employthe superstructure apart from the stabilizing base, he will long sincehave been able to profitably employ conventional therapeutic exercise,e.g. parallel bars, wheel chair, mat exercises, physical therapistexercises and daily activity exercises, such as bathing.

Obviously' modifications and variations of this invention are possiblein the light of the above teachings. It is therefore to be understoodthat within the scope of the appended claims, the invention may bepracticed otherwise than as specifically described.

What I claim as new and desire to secureby Letters Patent of the UnitedStates is:

1. An exercising device -for maintaining in standing posture a humanbeing, whose lower extremities are supported by separate artificialsupport means, during the performance of physical exercise during whicha portion of the trunk of the human being is conned within an enclosinggirding member, said device comprising in combination:

(a) an enclosing girding member subdivided into at least two connectedarcuate pieces,

(b) at least three longitudinally-extending extensible support membersvconnected to and depending from said girding member,

(c) stabilizer base means comprising a central platform and a pluralityof base members axed thereto and extensible therefrom, one of saidextensible base members being connected to the lower extremity of 20each of said support members and (d) hinge means connecting one of saidarcuate pieces to the rest of said girding member,

(1) said one of said arcuate pieces having a single support ymemberdepending therefrom and detachably connected to one of said extensiblebase members, whereby by detaching said single support member from theextensible base member connected thereto, and rotating said one of saidarcuate piecesk and said single support member together about said hingemeans, access may be readily provided into said girding member from theside.

2. The exercising device substantially as recited in claim 1 wherein thestabilizer base means is detachably connected to all the supportmembers.

References Cited UNITED STATES PATENTS 2,109,188 2/1938 Bajanova 272-572,448,304 8/1948 Gabel 248-48 2,580,932 1/1952 Lantry 272-57 2,772,88112/ 1956 Fundom 272-57X RICHA-RD C. PINKHAM, Primary Examiner.

P. E. SHAPIRO, Assistant Examiner.

